Abstract:[Objective] To investigate the clinical outcomes of arthroscopic cannulated screw fixation for Garden type III-IV femoral neck fractures in young adults. [Methods] A retrospective study was conducted on 40 young adults who underwent surgical treatment for Garden type III-IV femoral neck fractures in our department from January 2018 to December 2020. According to doctor-patient communi- cation, 18 patients underwent the arthroscopic reduction and fixation with percutaneous cannulated screws (the arthroscopic group), while the other 22 patients underwent traditional open reduction and internal fixation with cannulated screw (the traditional group). The periopera- tive, follow-up and imaging results were compared between the two groups. [Results] All patients in both groups had corresponding surgi- cal procedures performed successfully. Although the arthroscopic group consumed significantly longer operation time than the traditional group [(98.0±7.6) min vs (72.8±6.0) min, P＜0.05], the former proved significantly superior to the latter in terms of incision length [(36.27± 4.3) mm vs (94.7±5.8) mm, P＜0.05], fluoroscopy times [(3.1±0.8) times vs (7.2±1.5) times, P＜0.05], intraoperative blood loss [(38.7±5.6) ml vs (245.5±39.6) ml, P＜0.05] and hospital stay [(7.1±1.2) days vs (9.0±1.8) days, P＜0.05]. All the patients were followed up for a mean of (41.4±10.4) months, and the arthroscopic group resumed full weight-bearing activity significantly earlier than the traditional group [(92.6± 1.8) days vs (106.4±4.3) days, P＜0.05]. The VAS and Harris scores, as well as ranges of motion (ROMs) of hip extension-flexion and hip in- ternal-external rotation significantly improved over time in both groups (P＜0.05). There was no significant difference in VAS scores be- tween the two groups before surgery (P＞0.05), however, the arthroscopic group was significantly better than the traditional group in terms VAS score, Harris score, hip extension-flexion ROM and hip internal-rotation ROM at all corresponding time point after surgery (P＜0.05). Radiographically, there were no significant differences in Garden index, shaft-neck angle and T?nnis hip osteoarthritis grade between the two groups at any time points accordingly (P＞0.05). [Conclusion] The arthroscopic reduction and fixation with cannulated screws for dis-placed femoral neck fracture in young adults achieves manipulations under direct vision, with advantages of less intraoperative bleeding, less surgical trauma, less fluoroscopy times, shorter hospital stay, faster fracture healing, and better hip function recovery after surgery.